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Author Notes:

Correspondence: Kirtesh R. Patel Kirtesh.Patel@Yale.edu

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

We would like to thank the American College of Surgeons Commission on Cancer and the American Cancer Society for access to the data that enabled this analysis.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Research Funding:

Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Portions of this project were presented at the 22nd Society for Neuro-Oncology Annual Meeting on November 17, 2017 in San Francisco, CA.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • proton therapy
  • gliomas
  • overall survival
  • IMRT
  • NCDB

Proton vs. Photon Radiation Therapy for Primary Gliomas: An Analysis of the National Cancer Data Base

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Journal Title:

Frontiers in Oncology


Volume 8


, Pages 440-440

Type of Work:

Article | Final Publisher PDF


Background: To investigate the impact of proton radiotherapy (PBT) on overall survival (OS) and evaluate PBT usage trends for patients with gliomas in the National Cancer Data Base (NCDB). Methods: Patients with a diagnosis of World Health Organization (WHO) Grade I-IV glioma treated with definitive radiation therapy (RT) between the years of 2004-13 were identified. Patients were stratified based on WHO Grade and photon radiotherapy (XRT) vs. PBT. Univariate (UVA) and multivariable analysis (MVA) with OS were performed by Cox proportional hazards model and log-rank tests. Propensity score (PS) weighting was utilized to account for differences in patient characteristics and to minimize selection bias. Results: There were a total of 49,405 patients treated with XRT and 170 patients treated with PBT. Median follow-up time was 62.1 months. On MVA, the following factors were associated with receipt of PBT (all p < 0.05): WHO Grade I-II gliomas, treatment at an academic/research program, west geographic facility location, and surgical resection. After PS weighting, all patients treated with PBT were found to have superior median and 5 year survival than patients treated with XRT: 45.9 vs. 29.7 months (p = 0.009) and 46.1 vs. 35.5% (p = 0.0160), respectively. Conclusions: PBT is associated with improved OS compared to XRT for patients with gliomas. This finding warrants verification in the randomized trial setting in order to account for potential patient imbalances not adequately captured by the NCDB, such as tumor molecular characteristics and patient performance status. Importance of the Study: This is the first study that compares the outcomes of patients treated with photon based radiotherapy vs. proton based radiotherapy for patients with gliomas. In this retrospective analysis, the results demonstrate that proton therapy is associated with improved outcomes which support ongoing prospective, randomized clinical trials comparing the two modalities in patients with gliomas.

Copyright information:

© 2018 Jhaveri, Cheng, Tian, Buchwald, Chowdhary, Liu, Gillespie, Olson, Diaz, Voloschin, Eaton, Crocker, McDonald, Curran and Patel.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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